From the Guidelines
Gastric sleeve surgery can contribute to vitamin D deficiency, though it doesn't always cause it. After gastric sleeve surgery, patients have a reduced stomach size and may experience decreased absorption of fat-soluble vitamins like vitamin D. Additionally, patients often consume less food overall, which can limit dietary vitamin D intake. To prevent deficiency, most bariatric surgery programs recommend daily vitamin D supplementation of at least 2,000 IU, as suggested by the most recent study 1. Regular blood tests to monitor vitamin D levels are important, typically at 3,6, and 12 months post-surgery, then annually. Symptoms of vitamin D deficiency include fatigue, bone pain, muscle weakness, and mood changes. Vitamin D is essential for calcium absorption and bone health, and deficiency can lead to osteoporosis and other complications if left untreated. Some key points to consider:
- The prevalence of vitamin D insufficiency before bariatric surgery is high, with 85% of patients having 25(OH)D levels < 30 ng/mL 1.
- Postoperative vitamin D supplementation is crucial to prevent further reductions in 25(OH)D levels, especially in patients undergoing malabsorptive procedures 1.
- High-dose vitamin D supplementation (≥ 2,000 IU daily) is more effective in reducing the occurrence of postoperative hypovitaminosis D compared to lower doses [< 2,000 IU daily] 1. Most patients can maintain adequate vitamin D levels with proper supplementation and follow-up care after gastric sleeve surgery.
From the Research
Vitamin D Deficiency and Gastric Sleeve Surgery
- Gastric sleeve surgery can lead to vitamin D deficiency due to reduced food intake and malabsorption of fat-soluble vitamins, including vitamin D 2.
- A study found that vitamin D deficiency was common in patients undergoing bariatric surgery, including gastric sleeve surgery, with a prevalence of over 50% [<50 nmol/L] 2.
- However, daily supplementation with 2,000 IU of vitamin D3 and 1,500 mg calcium citrate can significantly increase 25(OH)D concentrations and reduce the percent of women who are vitamin D deficient 3.
- Another study found that vitamin D deficiency and insufficiency were prevalent pre-surgery and reduced significantly with routine supplementation post-surgery, with no significant differences between gastric bypass and sleeve gastrectomy procedures 4.
Risk Factors and Prevention
- Obesity is associated with chronic inflammation, which may contribute to adverse surgical outcomes, and vitamin D deficiency can further increase this risk 2.
- Determining the vitamin D status of bariatric surgery candidates and amending it preoperatively may prove greatly beneficial acutely and lifelong 2.
- Supplementation with additional specific nutrients, including vitamin D, is often needed to prevent deficiency after gastric bypass surgery 5.
Post-Surgical Vitamin D Status
- A study found that vitamin D levels increased significantly after bariatric surgery, with a mean increase of 8 ng/mL, and the percentage of patients with vitamin D deficiency decreased from 60.6% preoperatively to 26.1% after 3 months 3.
- Another study found that vitamin D deficiency and insufficiency were reduced significantly with routine supplementation post-surgery, with 8.9% and 26.7% of patients having deficiency and insufficiency, respectively, at 12 months 4.